Abstract
Objective:The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.Background:Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.Methods:Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.Results:After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.Conclusions:The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.
Highlights
The Swedish National Board of Health and Welfare classifies the use of prophylactic mesh around stomas as, ‘‘Research and Development,’’ because of the weak scientific evidence; larger randomized controlled trials (RCT) comparing prophylactic mesh with no mesh are required.[25]
In view of this uncertainty, we designed a double-blinded multicenter RCT to evaluate the effects of using a prophylactic mesh around the stoma
When comparing the mesh and nonmesh groups, there was no significant difference in the rate of bulge (P 1⁄4 0.631), clinically judged parastomal hernia (PSH) (P 1⁄4 0.866), or PSH on the computerized tomography (CT) (P 1⁄4 0.748) (Table 4)
Summary
The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. 1 retrospective trial comparing PSH rate before and after the introduction of routine prophylactic mesh around the stoma, at a unit that repeatedly produced top results in the Swedish Rectal Cancer Registry, showed no difference in complication rates between groups.[24] The Swedish National Board of Health and Welfare classifies the use of prophylactic mesh around stomas as, ‘‘Research and Development,’’ because of the weak scientific evidence; larger RCTs comparing prophylactic mesh with no mesh are required.[25] In view of this uncertainty, we designed a double-blinded multicenter RCT to evaluate the effects of using a prophylactic mesh around the stoma.
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